Ultrasound imaging of pediatric nail psoriasis

BACKGROUND: High-frequency ultrasound (US) of the nail in pediatric psoriasis remains underexplored. OBJECTIVE: To describe nail US features and Power Doppler (PD) activity in children with psoriasis. METHODS: Cross-sectional study of 43 consecutive patients evaluated with an 18-MHz probe and sensitive PD settings. Recorded variables included nail plate irregularity, trilaminar pattern, Wortsman classification and distal extensor enthesis. Demographic and clinical characteristics and nail physical examination were also collected. RESULTS: US abnormalities were identified in 46.5% of children. PD activity was present in 37.2%, including nails without clinical changes. Trilaminar loss was observed in 4.7%, and classic Wortsman-type patterns were uncommon. No distal extensor enthesitis was detected. Descriptively, PD positivity was observed in both clinically normal and clinically altered nails, without formal hypothesis testing. CONCLUSION: High-frequency nail US frequently reveals subclinical nail abnormalities in pediatric psoriasis, with PD signal in over one-third of patients and minimal entheseal involvement. These descriptive findings support the feasibility of pediatric nail ultrasound and highlight the need for pediatric-focused technical parameters and longitudinal controlled studies to clarify prognostic value.